Provider Demographics
NPI:1164758801
Name:OAKTON HEALTH CENTER SC
Entity Type:Organization
Organization Name:OAKTON HEALTH CENTER SC
Other - Org Name:NORTHSHORE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-329-0470
Mailing Address - Street 1:4860 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2953
Mailing Address - Country:US
Mailing Address - Phone:847-329-0470
Mailing Address - Fax:847-329-0472
Practice Address - Street 1:4860 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2953
Practice Address - Country:US
Practice Address - Phone:847-329-0470
Practice Address - Fax:847-329-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-31
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.124447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty